- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $33.11 / $134.90
| Facility | | $12.02 | $33.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $18.20
| Professional | | $10.00 | $12.02 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $64.57 / $64.57
| Facility | | $33.88 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $10.47 / $20.89
| Professional | | $6.76 | $10.47 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $31.62 / $69.18
| Facility | | $10.47 | $31.62 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.47 / $23.44
| Professional | | $7.76 | $10.47 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $29.51 / $44.67
| Professional | | $9.55 | $29.51 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $13.18 / $29.51
| Facility | | $12.02 | $13.18 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.98 / $18.62
| Professional | | $12.02 | $16.98 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $15.14 / $26.30
| Facility | | $7.59 | $15.14 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $10.47 / $20.89
| Professional | | $7.41 | $10.47 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |